When itchy skin means ICP (Intrahepatic Cholestasis of Pregnancy)

A bit of itching is normal in pregnancy, but for about 1% of women it can be a sign of a high-risk pregnancy condition. So if you are itchy then please read this just in case it applies to you:

OVERVIEW OF ICP (intrahepatic cholestasis of pregnancy)

ICP is a high-risk pregnancy condition, so it's important for your doctor to either rule it out or diagnose you so that treatment can begin. Although it's not believed to be harmful to the mother, it can affect the baby if left untreated. Researchers believe that with the right management, the risk drops to that of a normal low-risk pregnancy.

SYMPTOMS:
Itchy skin is the main symptom of ICP. The ICP itch can be mild or severe, constant or intermittent, in one or two random spots or all over. It is a misconception that you HAVE to itch on your palms and soles. There is no rash associated with ICP, but red inflamed skin and marks/bumps made from the scratching may be visible. Many women say the itch gets worse at night. Less common symptoms include dark urine, pale stools, pain under your ribs or shoulder blade, and some women get jaundiced. Women with a personal or family history of gallbladder/liver issues (even if their gallbladder has been removed) are at a slightly increased risk of developing ICP, as are women who are pregnant with multiples or those who have received IVF treatment.

RISKS:
High bile acid levels (over 40) are associated with preterm labor, fetal distress, meconium passage, postpartum maternal hemorrhage and in some severe cases even stillbirth. The idea is to keep the bile acid level as low as possible and deliver the baby early to reduce the risks.

DIAGNOSIS:
Diagnosing ICP is a process of elimination. Your doctor will need to screen you for any other causes of the itch and raised liver function (skin conditions such as eczema and liver conditions such as hepatitis).

There are 2 separate blood tests that you need to have: a bile acid test and a liver function test. Not all doctors are familiar with ICP, so it's a good idea to specifically make sure that they perform this test.

If your results come back normal but you continue to itch and can't find a reason, it's important to repeat these blood tests frequently since some women itch for weeks/months before their bile acid goes up. Most research suggests that in pregnancy bile acid over 10 (fasting) and 14 (non-fasting) is concidered "mild ICP", whereas anything over 40 is considered "severe ICP".

MORE INFO:
Here are some medical articles that you can read. If you feel that your doctor is not taking you seriously, you can print some of these and discuss with your doctor:community.babycenter.com/post/a4755...

Comments (160)

I remember being told to talk to my doctor about this. When I went she looked at it and said that from looking it was PUPS. I don't know what it really is.. But she says it's normal in pregnancy and she has seen some women get it horribly. And she said something about my palms or feet itching. But never said I should have blood work done.

I remember being told to talk to my doctor about this. When I went she looked...

Posted
07/15/2014

I remember being told to talk to my doctor about this. When I went she looked at it and said that from looking it was PUPS. I don't know what it really is.. But she says it's normal in pregnancy and she has seen some women get it horribly. And she said something about my palms or feet itching. But never said I should have blood work done.

That seems a little confusing. PUPPP and ICP are two different conditions (although a few women get both simultaneously). I know a lot of women who have been misdiagnosed because their doctor was not familiar with ICP.

PUPPP has a very distinctive hive-like rash, which usually starts in the areas where your skin is stretching and stretch marks are developing. It's not harmful, although can be very uncomfortable. See this link for more info and examples of how it looks =en.m.wikipedia.org/wiki/Pruritic_ur...

ICP a high risk condition that needs to be diagnosed and treated. Normally there is no rash associated with it, but it's quite common to have little bumps and red inflamed skin which is caused from the scratching itself. It often starts on the hands and feet but not always. For example I had severe ICP but didn't itch on my hands or feet.

Do you think you might have ICP? If so, the only way to know is by having blood tests.

I have a friend who is pregnant right now who has this. She says her hands and feet itch ALL the time very badly. She is going to be induced at 37 weeks because the chance stillbirth goes up if the baby is carried full term. I had never heard of it until she told me about it. Thanks for for doing your best to educate moms. :)

I have a friend who is pregnant right now who has this. She says her hands...

Posted
07/22/2014

I have a friend who is pregnant right now who has this. She says her hands and feet itch ALL the time very badly. She is going to be induced at 37 weeks because the chance stillbirth goes up if the baby is carried full term. I had never heard of it until she told me about it. Thanks for for doing your best to educate moms. :)

Do you know if your friend has support and info about ICP? Hopefully she does and is also on Urso. It's great that she's also spreading awareness by telling her friends what she's going through!

I have a dry skin patch on my hand. When I scratch it it causes little red bumps that ooze clear liquid. If I leave it alone it just looks like dry skin that inches, but g feels better when I run hot water. My doctor said not to worry about, but now I'm concerned. She has a nonchalant attitude about all of my issues. I'm high risk.

I have a dry skin patch on my hand. When I scratch it it causes little red...

Posted
07/22/2014

I have a dry skin patch on my hand. When I scratch it it causes little red bumps that ooze clear liquid. If I leave it alone it just looks like dry skin that inches, but g feels better when I run hot water. My doctor said not to worry about, but now I'm concerned. She has a nonchalant attitude about all of my issues. I'm high risk.

What makes you high-risk at the moment? I wouldn't worry too much about a small spot of dry skin, it sounds more like eczema or something like that. If the itching persists and/or gets worse then maybe look into it.

how did you get the doctor to agree to testing you for it? I have had issues with throwing up bile throughout my pregnancy, I asked my doctor to test for ICP and gallstones she said no... I went to the ER this past week with a gall stone attack... I have multiple stones and very nervouse already high risk IVF overweight, gallstones, my baby has a velantamous cord insertion I am scheduled to have a c section at 39 weeks and 3 days.... I think I will go earlier... I am being seen by high risk dr but I never get to meet with the dr. (makes no sense to me) I am going to start stress tests in about two weeks, but I can't seem to make my dr test my bile and liver functions... I am going to try and get the surgeon that I am meeting with today to say I need to have them monitored, any other suggestions would be great!

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